What Does It Take to Create IoT-based ECG Monitoring System

An IoT-based ECG monitoring system is a revolutionary invention that can help monitor heart health ✅ This is a proactive approach to patient care which can aid in revealing life-threatening heart diseases.

An Electrocardiogram or ECG is one of the most common and important tools to aid in the diagnosis of heart ailments. Through this tool, a visual representation of the heart’s pulses can be generated to help a doctor access a patient’s heart rhythm, blood flow, tissue health, size, and abnormalities.

A successful and timely ECG can spell the difference between life and death. Unfortunately, regular ECG machines are large, require a lot of wires and would need an ECG machine operator to run properly.

But with the innovations in mobile and IoT technology, it is now possible for a patient to be fitted with a portable ECG machine that can be measured and record electrocardiogram results anytime and anywhere using an IoT-based ECG monitoring system.

Advantages of an ECG monitoring system IoT app

Advantages of an ECG monitoring system IoT app

The IoT-based ECG monitoring system is still a new and experimental technology with only a few products sold commercially. But initial reactions from the users have yielded positive results, thus making a case for an ECG monitoring system as an IoT app as a good product to invest on.

For Patients

  1. Health buffs who actively track their physical progress can have a reliable tracker for heart activity.
  2. Users who have not yet been diagnosed with heart ailments like Atrial Fibrillation or AFib but occasionally encounter symptoms like irregular or skipping heartbeats. Using the ECG app they can monitor and record these symptoms for further analysis by doctors.
  3. Reveal possible heart conditions that could potentially lead to more serious diseases.
  4. Patients with existing heart ailments can monitor their health and medical progress.
  5. Aging patients will be alleviated of travel and stress every time they need an ECG.
  6. Some doctors suggest that the best use case for the ECG app is to monitor patients with existing heart problems, instead of monitoring otherwise healthy patients.
  7. Increase the level of awareness on heart care.

For Doctors

  1. The IoT-based ECG monitoring app will increase the general public’s view on the importance of heart care.
  2. New patients that will come in to verify their ECG readings and be certain with results.
  3. Remote monitoring of the patients via report sending, this can be done manually via email or other messaging platforms or the app can be designed to send digital reports automatically.

For Hospitals

  1. The ECG app can be used by hospitals as a an inexpensive and more portable version of the laboratory ECG machine. By equipping each of their staff with the ECG app, the hospital can check more patients.
  2. Since the ECG app is less intrusive than a standard laboratory ECG, the hospital can provide a better customer experience to confined patients. ECG tests can be done with the least amount of effort or inconvenience to the patient.
  3. The ECG app can increase the awareness of users on the importance of heart health. This will lead to an influx of new cardiac patients seeking professional verification of their ECG app results, adding more revenue to the hospital.

how to develop an ECG Monitoring system IoT App

A closer look at how to develop an ECG Monitoring system IoT App

Although the concept is still in its infancy, a couple of successful products have been launched. One notable ECG monitoring system based on Internet-of-Things is the ECG app on the Apple Watch Series 4. Let’s dive on how to develop another ECG monitoring app like Apple’s ECG App.

Commercial advantages vs common ECG

The current ECG apps can monitor heart activity for under a minute, usually set at 30 seconds. The motoring point can be either the wrist, as used by the Apple Watch ECG app, or the fingertips as used by Kardia, another popular ECG app. This means that the ECG app only utilizes a single probe to measure a single point or part of the body.

The laboratory grade ECG machines have 12 probes that can be attached to the chest and limb areas. This record pulses from 12 different parts of the body to get a more accurate result and a better picture of the patient’s heart condition.

First of, the current wearable technology will not deliver the same level of heart monitoring as a laboratory grade ECG Machine.

This being the case, the ECG app system is a lot more affordable than a full pledged ECG machines. The Apple Watch Series 4 comes with the ECG app natively installed sells for $400 and the Kardia IoT add-on, the KardiaMobiles, sell for $99. This provides you with unlimited ECG readings, anytime and anywhere.

For the common ECG machines, each monitoring will cost you about $50 and this would entail you to visit the physical location of the ECG machine, queue the line of patients and be strapped on for a few minutes.

For users requiring basic ECG monitoring, the readings from an ECG app is quick and economical compared to the common laboratory ECG machine.

Features to be considered

Below are the core elements to consider when building an ECG monitoring system as an Internet-of-Things application.

  1. Works as a wearable device - the main salable feature of the ECG app is it’s portability, allowing you to take ECG measurements anywhere, anytime. The ECG app should be able to run on a smart mobile device and either use the existing sensor terminals of the device or have a separate sensor device which can be conveniently carried or attached to the smart device.
  2. Possibility of connection to a cloud network - being an anywhere, anytime app means that it utilizes the redundant and stable cloud network where digital results can be stored and accessed.
  3. Remote monitoring - the system can be configured to send short reports to a cardiologist or to a personal trainer. This can be set automatically whenever you check for ECG measurements.
  4. Alarm system - current ECG apps only need to be activated either via touching a built-in sensor (Apple Watch) or an add-on (KardiaMobile). Upon measurements, the app can recognize anomalies in the heart readings which it can then flag as an alarm. An improvement that can be done is for the app to continually measure heart activity then send out alarms when an anomaly is detected.
  5. Reporting - each ECG reading will create a report stating standard information such as beats per minute and will also generate a finding based on the readings. This report is saved to a cloud-based environment and can be sent to a physician for analysis.

Cost to develop

Anyone who wants to develop their own remote camera control system app need to understand the basic components required to create IoT App. This list encompasses the end device, the infrastructure, and the core system.

Cloud server

The main location of the management system and repository of stored ECG readings (if enabled by the user). As with any server requirement, this can also be a physical hardware server configured to be accessed remotely.

Cost: This will be dependent on the scope of the project and can range from a few hundred dollars up to a few thousands of dollars. Although data storage will be minimal, the strength of redundancy and multiple node presence on different geographical locations will improve access and customer experience.

For reference, here is Amazon’s pricing for AWS cloud servers.

Heart or pulse sensors

This is assuming that you will use a separate add-on that will connect a smart mobile device. This device should be small and can connect to a smartphone via wireless using Bluetooth (recommended) and Wi-Fi, or physical wires. An example would be the Rohm’s Heart Sensor.

Cost: One sensor unit will range between $50 to $100 (customization and branding included).

Development of the system

This system will require seasoned app developers and the manpower or labor cost should be part of the overall project cost. This is considered an enterprise level app because of the telemetry requirements and the integration with a 3rd party sensor device. Below are items to be included in the development cost.
  • IoT user control system - this is the main user interface and should contain all the control and settings to properly display the ECG results.
  • MQTT or Message Queuing Telemetry Transport server - the primary messaging system that allows the server to receive transmitted readings in real-time.
  • Authentication - a user authentication system that filters access to the system and only allows logins of authorized personnel. This is an effective protection from hacking and other forms of illegal access.
  • Integration with device sensor - this M2M integration is the “heart” of the ECG app and must be seamless and error-free. The Constrained Application Protocol (CoAP), a low overhead communication system that can be the connecting “tissue” between the sensor, the smart device, and the internet.
  • End-user monitoring panel - this can be a web browser viewing platform that can be accessed by the user and authorized personnel, normally the user’s physician or cardiologist to directly access all ECG results.

Cost: $100,000 up to as high as $500,000.

Development timeline

Development timeline

A measuring app with telemetry functionalities for gathering data and integration with an IoT heart sensor equipment will approximately six (6) months to develop.

Overview of development process

  • Planning of business rules.
  • Gathering of requirements and proposed functionalities from owners.
  • Gathering and reviewing best practices from medical field experts.
  • Getting governing FDA requirements, concept and design approval.
  • Checking of similar or existing applications to find differentiation.
  • Lining up of feasible functionality and features.
  • User Experience and User Interface design.
  • Integration with heart sensors via API or hard code.
  • Telemetry system development using internet protocols, but for the ECG connectivity it is recommended to use MQTT as a TCP messaging protocol.
  • Back end or server end development and deployment to the cloud.
  • System testing using established tools like Cypress.
  • Testing of ECG accuracy on human users.

Concept to MVP

  • The concept paper is prepared and contains all the details of the project.
  • A paper prototype can be prepared showing workflows.
  • A basic version of the app can be commissioned to show look and feel.
  • Preparing the heart sensor prototype or bringing in a 3rd party supplier.
  • A working version of the App with all the functions working.
  • A complete system (app and sensor) that can measure, store ECG data and display gathered information in a readable format.

Possible causes for delay

  • Changing of designs and features or adding a feature while in development.
  • Not getting approval from governing FDA unit which can lead to possible government sanctions.
  • Not doing regular check-in meetings. A recommended method is the Agile development - a process wherein controls and checks are made to resolve problems early.
  • End user not providing information and support.
  • The heart sensor cannot be integrated with the ECG software.
  • If MQTT Messaging protocol is used, possible server incompatibilities with the cloud provider.
  • Catching other errors too late.

Recommendations for a speedy development process

  • If your in-house developers are not experienced enough to create an ECG monitoring system based on IoT or not familiar with the medical requirements, it is recommended that you outsource the project.
  • Identify with all stakeholders if the app will be available on both iOS and Android. devices. It is possible that each platform will require a different heart sensor since there will be different integrations.
  • It is advisable to outsource the supply of the heart sensors. Hold a bidding session with various suppliers to get multiple options.
  • If the native sensors of the mobile device will be used (e.g. fingerprint scanner as a finger sensor), check if technically feasible.
  • Always require an MVP before the final version.
  • Displaying and collecting of information should be compliant with Data Privacy laws.
  • During the testing phase, service providers should use an automated testing process to simultaneously run a batch of tests instead of manual testing.

Final thoughts

Innovations that can help keep a person’s health is a worthy investment of time and money. Heart conditions are one of the hardest ailments to monitor as even the best doctors might miss a diagnosis due to challenges in getting ECG measurements in real time. Some heart ailments, like palpitations, manifest only for brief periods of time and can easily be missed.

One can’t expect a patient to lie down, strapped to an ECG machine at a clinic for a whole day waiting for the palpitations to happen. The portability, mobility and easy to use interface are the value propositions of the ECG monitoring app making it a successful product.


If you plan to develop your own ECG monitoring system based on Internet-of-Things, why not partner with a company with a lot of real-world experience when it comes to app development and services. Give us a call or simply drop a message and our expert team of professionals can help analyze your needs and recommend a plan of action.

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